This resource provides current and comprehensive non-emergency health care information for school health nurses. Related procedures, instructional videos and downloadable skills checklists can be searched by selecting the [More Information] button at the bottom of this web page.
Overview
NOTE: In most instances Naloxone will be available in the school setting as a stock emergency medication and not as a student-specific medication. This document will focus primarily on stock Naloxone but will make note of when student-specific naloxone would require special considerations.
Opioid misuse and abuse amongst children and adolescents continue to be a concern across the country, including Missouri. Based on results from the Missouri Youth Risk Behavior Survey, in 2021, almost 17% of high school students reported ever misusing an opioid prescription (Missouri Department of Health and Senior Services, 2023). In 2022, there were 215 Missouri residents, aged 0-24 who died from a drug overdose (Missouri Department of Health and Senior Services, n.d.a.). As a result of concerns related to opioid use many schools have begun to stock naloxone. Numerous organizations, including the American Medical Association (AMA), The White House, and the National Association of School Nurses support stock naloxone in the school setting (AMA, 2023; Cardona & Gupta, 2023; NASN, 2020b).
Opioid Drugs:
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others (National Institute on Drug Abuse, n.d.).
Those at Increased Risk for Opioid Use:
Per the Centers for Disease Control and Prevention (CDC) (2022a), the following are risk factors for youth high-risk substance use:
- Family history of substance use
- Favorable parental attitudes towards the behavior
- Poor parental monitoring
- Parental substance use
- Family rejection of sexual orientation or gender identity
- Association with delinquent or substance using peers
- Lack of school connectedness
- Low academic achievement
- Childhood sexual abuse
- Mental health issues
Additionally, studies have found youth who have experienced the following are at increased risk of opioid abuse:
- Medical use of a prescription opioid
- Depressive episode
- Increased symptoms of an affective disorder in addition to increased symptoms of anxiety, somatic, attention, and conduct disorders
- Childhood emotional or physical abuse (Yule, Lyons, & Wilens, 2018).
Risk Factors for Overdose:
The following factors can increase a person’s risk for overdose:
- Mixing opioids with other substances including benzodiazepines or alcohol
- Using after a break in use due to decreased tolerance
- “Tolerance develops when someone uses an opioid drug regularly so that his or her body becomes accustomed to the drug and needs a larger or more frequent dose to continue to experience the same effect. Loss of tolerance occurs when someone stops taking an opioid after long term use. When someone loses tolerance and then takes the opioid drug again, he or she can experience serious adverse effects, including overdose, even if the amount taken had not caused problems in the past” (Substance Abuse and Mental Health Services Administration (SAMHSA), 2018, p. 1).
- Taking too many opioids
- Existence of other health conditions
- Previous overdose
- Using opioids not from a pharmacy because the strength is unknown
- Using alone (increases risk from dying from an overdose)
(Centers for Disease Control and Prevention (CDC), 2022b; Washington Office of Superintendent of Public Instruction, 2022).
Opioid Intoxication vs. Opioid Overdose:
The first step when questioning whether someone is experiencing an opioid intoxication versus opioid overdose would be to assess the individual’s breathing and responsiveness. If there are any concerns, emergency medical services (EMS) should be called.
Table 1. Opioid intoxication vs. opioid overdose
| Opioid Intoxication | Opioid Overdose |
| Relaxed muscles | Pale, clammy skin |
| Slowed or slurred speech, slowed or shallow breathing | Speech infrequent, not breathing, very shallow breathing |
| Appears sleepy, nodding off | Deep snorting or gurgling |
| Responds to stimuli | Unresponsive to stimuli (calling name, shaking, sternal rub) |
| Normal heart rate/pulse | Slowed heartbeat/pulse |
| Normal skin color | Cyanotic skin coloration (blue lips, fingertips) |
Source: Massachusetts Department of Public Health, n.d.; National Association of School Nurses, 2023).
Assessing Students for Opioid and Other Substance Use:
The school nurse may become aware of a student who is abusing drugs or may have a student present to the health room that appears to be under the influence or have a suspected overdose. The school nurse’s first priority would be the health and safety of the student. The school nurse should assess the student to determine if cardiopulmonary support needs to be provided and/or emergency services need to be contacted.
If the school nurse suspects that the student may be using substances and it is not an emergent situation there are assessment tools that the school nurse may want to use as they assess the student (see Assessments and Screenings in the Resources section). The school nurse should be aware of school district policies related to their role in assessing students for potential substance use. In addition, the school nurse should determine their responsibility related to reporting suspected substance use to school leaders, parents/guardians, and local law enforcement.
The school nurse should be aware of local resources and treatment options for students who are interested in obtaining treatment for their substance use. Considering that many youth who abuse substances also have underlying mental health concerns, the school nurse should offer those resources to students and parents as well (Johnson & Selekman, 2019).
Delegation
Although the Missouri Nurse Practice Act allows a school nurse to delegate the administration of naloxone in the school setting, the school nurse should answer the following delegation questions. Note the following questions are based on the scenario that stock naloxone is being administered to a student who has not received a prior assessment by the school nurse and whose health history is not completely known to the school nurse.
Questions to Ask to Inform Safe Delegation: The delegation questions below are based on the American Nurses Association’s Decision Tree for Delegation by Registered Nurses (ANA, 2012) and the National Association of School Nurses’ Emergency Medication Administration Delegation Decision Tree (NASN, 2020a).
- Does school district policy, the school nurse’s job description, and the UAP’s job description allow the delegation of naloxone administration?
Although the Missouri Nurse Practice Act allows for registered nurses to delegate administration of naloxone to school staff, the school nurse should ensure that the district does not have policies that prohibit or limit the school nurse’s ability to delegate. Additionally, the school nurse should review their own and the UAP’s job description to confirm that it is appropriate to delegate this procedure. - Is the school nurse competent to perform this procedure or does the school nurse need to acquire some knowledge or skills to be competent in this procedure?
If the school nurse does not have the knowledge or skills or does not feel comfortable performing this procedure, they should not delegate this procedure to a UAP. The school nurse must first acquire the necessary knowledge and skill to perform this procedure competently before they can delegate it to someone else. - Are the results of the naloxone administration reasonably predictable?
If the results of the naloxone administration are not predictable then this procedure should not be delegated. - Does the UAP have the appropriate knowledge, skills, abilities, and willingness to perform the procedure?
All these factors need to be considered. Although a UAP may be competent to perform the procedure they may not be willing to do so and in that situation another UAP should be identified and trained. The registered nurse must retain responsibility for the procedure until training is complete. - Is there a procedure and/or protocol in place for this procedure?
A delegated nursing procedure must have an established sequence of steps that the UAP can follow. These steps should have a predictable outcome. The steps should be outlined in a written procedure or protocol. If the written procedure/protocol has not been developed, the school nurse should retain responsibility for the procedure until the procedure/protocol is in place. - Is the school nurse able to provide supervision to the UAP (direct or indirect depending on the situation)?
If the school nurse is not able to provide supervision, then the procedure should not be delegated. The school nurse will need to assess the situation to determine if direct or indirect supervision is required. The school nurse may also need to reassess the situation if the environment changes, for example, if the procedure is going to be performed during a time that the school nurse is not contracted to provide nursing services (i.e., over the weekend, during the summer, or if the school nurse is part-time).
The Decision to Delegate:
There may be times when the school nurse and school administrator have conflicting opinions on the delegation of a procedure to a UAP. The school nurse may feel that delegation is not appropriate, or the administrator may want the school nurse to delegate a procedure to an UAP that the school nurse feels is not competent. In these situations the school nurse may need to educate the administrator that the school nurse has a professional and legal responsibility to determine if delegation of a nursing procedure is appropriate and safe (ANA, 2012).
A resource developed by the National Association of School Nurses entitled, Fact Sheet for School Administrators, Families, and School Personnel: Nursing Delegation Requires the School Nurse may assist the school nurse in communicating with the school administration.
For continued learning on delegation see Navigating Delegation in the School Setting (PDF)
School Environment
The Substance Abuse and Mental Health Services Administration (SAMHSA) encourages ready access to naloxone. They state, “Individuals who are concerned about the risk of an opioid overdose, including people who use prescription or illicit opioids, their family members, friends, caregivers, or concerned members of the public should consider having naloxone on hand. This allows individuals to have naloxone available to administer if they witness someone experiencing an overdose” (SAMHSA, 2023b). “Ensuring ready access to naloxone in schools, including elementary schools, aligns with Health and Human Services’ strategic approach to prevent overdose deaths. With naloxone as part of an emergency protocol and readily accessible, a school nurse or other staff members can quickly administer it” (SAMHSA, 2023b).
Stock Naloxone:
When planning for a stock naloxone program the school nurse should consider the following (the questions below are based on the Questions to Consider document in the National Association of School Nurse’s (NASN) Naloxone Toolkit).
Questions to Consider in Development of a School Stock Naloxone Program:
State Laws:
- Are there state laws that currently prohibit the administration of stock naloxone in schools?
- Does the state have a Good Samaritan law or equivalent?
- Does the state have exemption from liability laws for medication administration or emergency care?
- Does your state nurse practice act and other relevant laws allow the school nurse to delegate the administration of naloxone to unlicensed assistive personnel (UAP)?
District Policies:
- Is a policy required to develop a stock naloxone program in the district?
- Per the Missouri Department of Health and Senior Services (n.d.b.), “a district that chooses to stock naloxone for emergency use should modify the emergency medications section of their policy. In addition, school districts should consider or determine if policies for medical emergencies involving staff and visitors to district property are addressed. If a district chooses to make naloxone available for emergency use for staff members or members of the public, other policies may need modification accordingly” (p.2).
- Does the district administration support a stock naloxone program?
- Does the school board support a stock naloxone program?
- Does your district medical advisor support a stock naloxone program?
- Does the district policy allow the delegation of naloxone to UAPs?
School Nurse Practice:
- Is delegation of naloxone administration to UAPs a safe decision based on the structure of the school environment, school nurse: pupil ratio, and other roles and responsibilities of the school nurse?
- Are there enough UAPs willing and competent, in each school building, to administer naloxone to ensure a safe and timely response to a potential overdose?
Education for Administration of Naloxone:
- Who will be responsible for educating and training staff who will have responsibility to administer naloxone?
- The training should include:
- Signs and symptoms of overdose
- How to respond to an overdose
- When to administer naloxone
- How to administer naloxone
- Supportive care to provide before and after naloxone administration
- Documentation of the event and medication administration
- Current legislation regarding naloxone
- The training should include:
- How will the UAP determine when naloxone should be administered?
- What education and training should be provided regarding the potential side effects that can be expected?
- What education will be provided on supportive care to be provided before and after naloxone has been administered?
- How often will education and training be provided?
- Will the UAPs trained to administer naloxone also be required to be certified in CPR?
Medication and Storage:
- Where can the district obtain a standing order from?
- Missouri has a standing order for every school in the state. Section 192.206. RSMo, authorizes the Director of the Department of Health and Senior Services to authorize a Missouri licensed physician to issue a statewide standing order for an opioid antagonist. A standing order may also be written from your district’s physician or medical director (Missouri Department of Health and Senior Services, n.d.b., p. 4).
- Who will be responsible for procuring and maintaining naloxone?
- Who will be responsible for monitoring the naloxone expiration date?
- How many doses will schools have in each building?
- Per the Missouri Department of Health and Senior Services (n.d.b.) “as with any emergency drug, the number of doses that will be needed is difficult to predict. While there is a significant amount of data about opioid use and overdose in Missouri, Missouri School Board Association (MSBA) did not find any data specific to schools. Since emergency response personnel usually carry naloxone, a district might factor in response time when determining how many doses to stock in each building. If a district has access to local statistics about opioid use levels, this should be considered as well. The local health department may have such information. Naloxone only works in the body for 30 to 90 minutes. It is possible for a person to still experience the effects of an overdose after naloxone wears off or need multiple doses if a potent opioid is in a person’s system” (p. 4).
- Where will naloxone be stored?
- Will standing order allow for administration of a second dose?
- If so, protocol should include indications and instructions for a second dose.
- If so, schools should have adequate supply of naloxone to allow a second dose to be administered.
- How will the district fund further supply of naloxone?
- Check with your local health department to see if free Narcan is available in your area.
- The Missouri State Board of Pharmacy has announced that any pharmacy in the state may dispense naloxone without a prescription. In addition, it may be purchased online. Prices vary. The shelf life for naloxone is 18-24 months.
- Will the continued procuring and maintenance of naloxone be cost prohibitive for the school district?
- Will the stock naloxone be available for before/after school events and school sponsored events?
- Will the stock naloxone be available for community groups using the building for non-school sponsored events?
- Will the standing order for naloxone allow the administration of the medication to staff and visitors?
- Which formulation of naloxone will your district stock? (i.e., intramuscular vs. intranasal)
- Does standing order require a specific formulation of naloxone?
Community Need:
- What is the average response time in the community for emergency medical services (EMS)?
- Do local EMS, fire department and/or law enforcement personnel carry naloxone?
- Have EMS had to administer naloxone in a school setting or school sponsored activity before?
- Do school police officers or safety resource officers carry naloxone?
- Are there other groups/individuals working on naloxone access and administration issues in your community?
- Have you connected with them to collaborate efforts?
- Is there a heroin/opioid task force within your community or state?
- Have you connected with them to collaborate efforts?
(NASN, 2023)
Naloxone Administration Policy: The Missouri Department of Health and Senior Services (n.d.b.) recommends a “district that chooses to stock naloxone for emergency use should modify the emergency medications section of their policy. In addition, school districts should consider or determine if policies for medical emergencies involving staff and visitors to district property are addressed. If a district chooses to make naloxone available for emergency use for staff or members of the public, other policies may need modification accordingly” (p. 2).
Students
A student who requires the administration of naloxone in the school setting may or may not be known to the school nurse. It is also possible that the student has kept their drug use a secret so the nurse or other school staff may have no prior knowledge.
As the school nurse meets with students, they may want to consider assessing the student for risk factors related to possible drug use. These include:
- Family history of substance use
- Favorable parental attitudes towards the behavior
- Poor parental monitoring
- Parental substance use
- Family rejection of sexual orientation or gender identity
- Association with delinquent or substance using peers
- Lack of school connectedness
- Low academic achievement
- Childhood sexual abuse
- Mental health issues (CDC, 2022b).
For more information on screening and assessing students for substance use see “Assessing Students for Opioid and Other Substance Use” in the Overview section.
Communication
Opioid overdose risk reduction and response requires effective communication with and between multiple stakeholders. Not only do school administrators, the school nurse, medical advisor, teachers, and other school staff need to work collaboratively to establish an opioid overdose response plan but school leaders and educators also need to communicate with students and families about substance abuse and the potential for overdose.
Opioid Overdose Risk Reduction and Response:
In addition to school administrators, the school nurse, medical advisor, teachers, and other school staff, the school may also want to consider including local Emergency Medical Services (EMS), including police, fire, and ambulance, parents, students, and other community organizations who are working to combat opioid use and abuse to join planning meetings related to opioid overdose risk reduction and response. For more information on developing a Stock Naloxone Program see “Questions to Consider in Development of a School Stock Naloxone Program” in the School Environment section.
Student and Parent Education:
Education of parents/guardians and students is key to preventing the misuse of drugs. It is recommended that parents/guardians receive education on:
- How to safeguard medications at home
- Why medication should not be used by those for whom it was not prescribed
- Dangers of mixing medications
- Steps they should take to safeguard and monitor their prescriptions, including the number of pills they have along with keeping track of refills
- This information should also be given to other relatives that students have frequent interactions with (i.e., grandparents whom the student regularly visits) (Johnson & Selekman, 2019).
Communication Post Naloxone Administration:
Another important aspect of an effective opioid overdose risk reduction and response plan would be to debrief anytime naloxone was administered in the school setting. It would be important for all those involved to review what occurred and if any changes to the plan need to occur. Some potential debrief questions to consider would be:
- Was the need for assistance clearly communicated before the incident?
- Was the need for assistance clearly communicated during the incident?
- Were roles and responsibilities understood by all team members?
- How are staff members involved in the incident coping?
- What went well?
- Why?
- What didn’t go well?
- Why not?
- What can we do better next time?
Medication
Naloxone:
Naloxone is an opioid antagonist medication used to treat an opioid overdose. Although naloxone is not an opioid, it binds to opioid receptors. When naloxone binds to the opioid receptors, it displaces the opioids and blocks their effect in the brain and reverses respiratory depression which are usually the cause of overdose deaths (SAMHSA, 2023b).
Naloxone is an appropriate response for all opioid overdose events, including fentanyl-involved overdoses. Multiple doses of naloxone may be required when the overdose results from ingestion of large amounts of opioids or potent opioids such as fentanyl, carfentanil, or other opioid analogs (SAMHSA, 2018). Naloxone is a temporary treatment and its effects do not last long. The naloxone works to reverse the effects of the opioid overdose for only 30 to 90 minutes, therefore, it is critical to obtain medical intervention as soon as possible after administering/receiving naloxone (National Institute on Drug Abuse, 2022).
Naloxone is a relatively safe medication when used appropriately to reverse opioid overdose. However, it is important to note that naloxone can cause withdrawal symptoms in people who have had an overdose reversed since they may be physically used to having opioids in their system. Opioid withdrawal symptoms include agitation, nausea, vomiting, sweating, and elevated heart rate. These symptoms are typically not life-threatening and can be treated. Administering naloxone to someone who is not experiencing an opioid overdose is safe and generally should not cause harmful health effects (SAMHSA, 2023b).
Student Possession of Naloxone:
As of August 28, 2017, anyone in Missouri can get naloxone at a Missouri pharmacy without a prescription (Time to Act, n.d.). This may mean that a student may have access to naloxone. The school nurse should review their school’s Medication Administration Policy and Procedure to determine what authorizations are required for the administration and/or self-possession and self-administration of medications.
Field Trips
n most instances schools will only have stock (non-student specific) naloxone. As with other stock emergency medications (i.e., epinephrine, albuterol, glucagon) schools will need to decide if stock medications will be brought on field trips or school-sponsored activities or will only be administered to students when they are on the school premises.
Documentation
Stock Naloxone:
Standing Order: A standing order would be required for school districts to have stock naloxone. Missouri has a standing order for every school in the state. Section 192.206. RSMo, authorizes the Director of the Department of Health and Senior Services to authorize a Missouri licensed physician to issue a statewide standing order for an opioid antagonist. A standing order may also be written from your district’s physician or medical director (Missouri Department of Health and Senior Services, n.d.b, p. 4).
Naloxone Administration Protocol: The school district should have a naloxone administration protocol that outlines the steps that should be taken when a student has experienced a suspected opioid overdose. The Missouri Department of Health and Human Services has a Sample Naloxone Protocol in their Naloxone Toolkit.
Student-Specific Naloxone:
Health Care Provider Order: As naloxone is an over-the-counter medication, an order from a health care provider would not be required if the medication is supplied by the parents/guardians to be administered to a specific student (not stock naloxone).
Parent/Guardian Authorization:
Stock or Student-Specific Naloxone:
Medication Administration: Administration of naloxone will need to be documented, whether it is administered by the school nurse or a UAP and whether the medication was student-specific or stock mediation. Many times the medication administration is documented in the student’s health record. The school nurse will want to ensure that the documentation is completed for the administration of naloxone during field trips (if applicable), before or after school, and/or during any school-sponsored activities.
The Missouri Department of Health and Senior Services Naloxone Toolkit has a sample Naloxone Administration Report.
Staff Competency Validation: If the naloxone administration is delegated to a UAP the school nurse should document that the UAPs knowledge, abilities, and skills have been assessed. Many times these factors are documented on a skills competency checklist (see Narcan Administration Skill Competency Checklist). There should be a place on the skills competency checklist for the school nurse and UAP to sign to indicate that they feel competent and are willing to perform the procedure. Once the procedure has been delegated the school nurse is responsible for periodic evaluation of the UAP and their competency. The school nurse must determine how often the supervision is needed. After the school nurse has re-evaluated the UAP’s competency, they should document the date of the evaluation (Shannon & Kubelka, 2013; Selekman & Ness, 2019). The school nurse should organize the competency documentation in a way that easily allows them to determine when subsequent evaluation and documentation of competency is needed. For more information on delegation see the Delegation section.
Procedure
Go to Emergency Preparedness
Emergency Preparedness is at the core of a stock naloxone program in a school setting and the key to emergency preparedness is education, training, and practice. The following information should be provided to all school staff: Staff who will be responsible for administering naloxone should receive education regarding: In addition to education and training, the school nurse should facilitate emergency preparedness drills to ensure that staff know how to respond. The Readiness and Emergency Management for Schools (REMS) Technical Assistance (TA) Center has developed Preparing for Opioid-Related Emergencies for K-12 Schools and Institutions of Higher Education. StopOverdose.org and the NASN Naloxone Toolkit have training resources. For more information on emergency planning see Missouri School Boards’ Association’s Emergency Planning Guide for Students and Staff with Special and Functional Needs within Schools. There are a few Missouri statutes that relate to the administration of naloxone. They include: The National School Boards Association has developed Drugs, Substance Abuse, and Public Schools–A Legal Guide for School Leaders Amidst Evolving Social Norms With a foreword by the National Association of School Nurses which has helpful information regarding student drug and substance use. Assessment and Screening: Opioids: Emergency Planning: NASN Naloxone Toolkit: Resources for Students and Families: Resources for Schools: Access to naloxone: Naloxone administration: American Medical Association. (2023, June 13). Put naloxone in schools so it can save lives. American Nurses Association. (2012). Principles of delegation. Cardona, M.A. & Gupta, R. (2023, October 30). Letter to schools. CDC. (2022a). High-risk substance use among youth. CDC. (2022b, November 3). Risks and how to reduce them. Deitche, A. L., & Burda, A. M. (2022). Management of toxicological emergencies in the school setting: Part 1 An overview for school nurses. NASN School Nurse (Print), 37(4), 184–189. Johnson, K. & Selekman, J. (2019). Students engaging in high-risk behaviors. In J. Selekman, R. A. Shannon, & C. F. Yonkaitis (Eds.). School nursing a comprehensive text. (3rd ed., p. 839). (Philadelphia, PA: F. A. Davis Company. Massachusetts Department of Public Health. (n.d.). Opioid overdose education and naloxone distribution naloxone pilot project core competencies. Minnesota Department of Health. (2023, November 7). Naloxone administration in school settings toolkit. Missouri Department of Health and Senior Services. (n.d.a.). Drug overdose dashboard – Fatal overdoses. Missouri Department of Health and Human Services. (n.d.b.). Naloxone toolkit. Missouri Department of Health and Senior Services. (n.d.c.). Questions to consider in development of naloxone protocol in Missouri school programs. Missouri Department of Health and Senior Services. Office of Epidemiology. (2023, December). 2021 Missouri youth risk behavior survey report. Youth risk behavior survey 2021. Missouri Revised Statute: 195.206 RSMo. (2022, August 28). Opioid antagonist or addiction mitigation medicine, sale and dispensing of by pharmacists, possession of — administration of, contacting emergency personnel — immunity from liability, when. Missouri Statute 338.205 RSMo. (2016, August 28). Opioid antagonist, storage and dispensing of without a license, when. — National Association of School Nurses. (2020a). Emergency medication toolkit. National Association of School Nurses. (2020b). Naloxone in the school setting (Position Statement). Author. National Association of School Nurses. (2023, September 8). Naloxone education for school nurses toolkit. National Institute on Drug Abuse. (n.d.). Opioids. National Institute on Drug Abuse. (2022, January). Naloxone drug facts. SAMHSA. (2018). SAMHSA opioid overdose prevention toolkit. SAMHSA. (2023a, December 8). Naloxone. SAMHSA. (2023b, April 24). Non-prescription (“Over-the-Counter”) naloxone frequently asked questions. Selekman, J. & Ness, M. (2019). Students with chronic conditions. In J. Selekman, R.A. Shannon, C.F. Yonkaitis, (Eds.). School nursing, a comprehensive text (3rd ed., p 493). Philadelphia PA.: F. A. Davis Co. Shannon, R. A., & Kubelka, S. (2013). Reducing the risks of delegation: use of procedure skills checklists for unlicensed assistive personnel in schools, Part 2. NASN School Nurse (Print), 28(5), 222–226. Time to Act. (n.d.). What you need to know about naloxone in Missouri. Washington Office of Superintendent of Public Instruction. (2022, January). Opioid-related overdose policy guidelines & training in the school setting. Yule, A. M., Lyons, R. M., & Wilens, T. E. (2018). Opioid use disorders in adolescents-Updates in assessment and management. Current Pediatrics Reports, 6(2), 99–106. Renee Falkner, BSN, RN Katherine Park, DNP, RN, NCSN Last updated 4/18/2025
Legal Issues
Resources
Missouri Resources:
Drug Takeback:
References
Reviewers
School Nurse Supervision Specialist | Therapylog
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing